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Biomedical subjects

V Allgar

Publications and source records attributed to V Allgar.

15 recordsLinked to original sources
PubMed2003

Oral glutamine in paediatric oncology patients: a dose finding study.

OBJECTIVE: The purpose of this study was to determine the most appropriate dose of oral glutamine to use in a further clinical study in paediatric oncology patients. DESIGN: This was a phase I, pharmokinetic study. SETTING: The study was carried out at The Yorkshire Regional Centre for Paediatric Oncology and Haematology, St James's University Hospital, Leeds, UK. SUBJECTS: Thirteen patients undergoing treatment for paediatric malignancy participated in this study. All 13 completed the study. INTERVENTIONS: The most appropriate dose was determined by patient acceptability and by plasma glutamine and ammonia levels measured at timed intervals after ingestion of a single glutamine dose. RESULTS: Doses of 0.35, 0.5 and 0.65 g/kg were well tolerated with no untoward plasma glutamine and ammonia levels. One patient was recruited to a higher dose of 0.75 g/kg, but the plasma glutamine and ammonia levels peaked at 2601 and 155 micro mol/l, respectively. The ammonia level was greater than the acceptable upper limit. It was difficult to disperse the glutamine adequately at this dose, resulting in the suspension being found to be unpalatable and therefore no further patients were recruited at this dose. CONCLUSION: It was concluded that 0.65 g/kg is a safe dose of glutamine to use in a clinical study in paediatric oncology patients.

Administration, Oral↗
PubMed2001

Endotoxin, cytokines and lipid peroxides in children with intussusception.

BACKGROUND: Intussusception is a relatively common paediatric surgical emergency. The aim of this study was to investigate selected inflammatory mediators in children with acute intussusception and to identify potentially useful plasma markers of clinical outcome. METHODS: Clinical, radiographic, operative and pathological details were recorded prospectively of all children presenting to a single institution with a confirmed diagnosis of acute intussusception during 1 year. Paired acute and convalescent venous blood samples were collected in a standard manner for blinded analysis of the following: malondialdehyde, C-reactive protein (CRP), interleukin (IL) 6, neopterin, tumour necrosis factor alpha, endotoxin, and immunoglobulin (Ig) G and IgM antiendotoxin core antibody (EndoCAb). RESULTS: Thirty-two consecutive children (23 boys, nine girls) with a median age of 4 months were studied. Acute ileocolic intussusception was managed by air enema reduction (n = 19), operative reduction (n = 8) or surgical resection (n = 5). Peripheral blood cultures were sterile. Acute levels of plasma IL-6, neopterin and CRP were significantly raised in comparison to both normal laboratory ranges and convalescent samples (P < 0.001). Using stepwise discriminant analysis, CRP was identified as the best variable at distinguishing between the three treatment groups (P < 0.001). IgM EndoCAb concentrations were significantly greater in the convalescent sera of all the patients (P < 0.001). CONCLUSION: Acute ileocolic intussusception in childhood is associated with endotoxinaemia and significantly raised levels of circulating inflammatory cytokines. Plasma CRP at diagnosis showed a statistically significant positive correlation with disease severity.

Biomarkers↗
PubMed2001

Going home from hospital: the carer/patient dyad.

AIMS: This study aimed to provide an in-depth understanding of the process of hospital discharge experienced by the carers of patients 'at risk' of unsuccessful discharge from medical wards in three hospitals in the North of England. BACKGROUND: The Community Care Act and the Carers Recognition and Services Act placed responsibility on service providers to ensure the smooth discharge of patients from hospital making sure that appropriate community services are in place to support the patient and their informal carer following discharge from hospital. The study, from which this paper is taken, identified patients at risk of unsuccessful discharge and tracked the experiences of the patient and their carer through the discharge process. For the purpose of the study unsuccessful discharge is defined as unplanned readmission within 6 weeks of discharge or extended length of stay. DESIGN: The study combined qualitative and quantitative methods to identify factors leading to unsuccessful discharge. Logistic regression was used retrospectively with the records of 1500 patients to identify factors predicting unsuccessful discharge. A sample of medical patients predicted to be at risk of unsuccessful discharge, their formal and informal carers, were followed through the discharge process using qualitative techniques to look at decision-making and outcomes related to discharge. FINDINGS: This paper presents findings relating to patient/carer experiences of the discharge process. It explores the obligate moral climate in which the role of carer is negotiated between professionals, patients, family members, friends and neighbours and the differing assumptions about duty associated with caring roles in hospital and in family and community settings. CONCLUSION: The discussion adopts a critical theory perspective to examine the contradictions confronting practitioners, patients and carers arising from hospital policies which promote cost-effective and efficient use of expensive technical resources while simultaneously seeking to identify and meet the needs of patients and carers for care.

Adolescent↗
PubMed2001

The development of a protocol for the use of 5-HT3 antagonists in chemotherapy-induced nausea and vomiting.

The purpose of this study was to evaluate the effectiveness of three 5-HT3 antagonists in routine clinical practice. The ultimate aim was to develop an antiemetic protocol, selecting a single 5-HT3 antagonist. Each of the drugs was studied for a 4-month period and data was collected from patients on nausea, vomiting (both acute and delayed) and side-effects by means of a diary card. A total of 274 patients were enrolled into the study. Success rates for acute emesis seen over the study period were in excess of 90%. There were no statistically significant differences between any of the three drugs investigated with respect to both acute and delayed nausea and vomiting. Similarly, there was no difference between the three groups for the incidence of constipation, diarrhoea and headache. Granisetron demonstrated a lesser deviation from the protocol in respect of the number of intravenous doses given to patients. The study allowed an effective 5-HT3 antagonist protocol to be developed for use in the management of nausea and vomiting in cancer patients.

Adolescent↗
PubMed2001

Utero-ovarian blood flow characteristics of pituitary desensitization.

BACKGROUND: Down-regulation in assisted reproduction treatment cycles is monitored by suppression of ovarian/pituitary hormones and/or measurement of endometrial thickness. METHODS: This prospective longitudinal study reports on utero-ovarian characteristics of pituitary desensitization. A total of 75 patients were recruited; 32 had IVF treatment, 20 frozen--thawed embryo transfer cycles and 23 patients were recipients of donated oocytes. All received early follicular-phase down-regulation and had colour flow Doppler velocimetry of the utero-ovarian arteries < or =3 days before the start of menses and after 21 days of gonadotrophin-releasing hormone (GnRH) analogue treatment. Ovarian volume, endometrial thickness, pituitary and ovarian hormone concentrations were recorded at each scan. RESULTS: Significant changes (P < 0.05) were noted in these and utero-ovarian vasculature during the down-regulation period, with good correlation between resistance index and oestradiol estimations. Neither the type of GnRH analogue nor age influenced the changes in utero-ovarian blood flow. Ovarian artery resistance index was the best Doppler predictor for pituitary suppression and a mean discriminatory cut-off value of 0.867 +/- 0.025 was found to have the highest specificity and positive predictive value. CONCLUSIONS: This study has, for the first time, defined cut-off values for satisfactory pituitary suppression with high positive predictive value and specificity in an early follicular phase long protocol of GnRH analogue down-regulation using colour flow Doppler.

Adult↗
PubMed2001

First wave PMS pilots: a critical analysis of documentation.

Contracts and interim local evaluation reports for the 14 first wave PMS pilots in Northern and Yorkshire region were analysed by documentary analysis. Both contracts and reports were found to vary considerably in size and scope. Most contracts contained aims and objectives that were too broad or vague to guide project management and they lacked useful milestones. This made it difficult to identify criteria for measuring success. The local evaluation reports were also of variable quality. It is recommended that contracts should be accompanied by a development plan containing specific objectives, timescale and process for implementation as well as an evaluation strategy. The relative importance of different targets should be agreed and specified at the outset, to allow weighting of partial success, where some objectives, but not others, are achieved. Project milestones would be made explicit and measurable in the development plan. More clarity in contracts and evaluation for future pilots is essential.

Continuity of Patient Care↗
PubMed2001

Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents.

BACKGROUND: Obstructive sleep apnoea (OSA) has been shown to be associated with an increased risk of road traffic accidents (RTAs). Predicting the driving ability and risk of RTAs in an individual with OSA is difficult. On-road testing is the gold standard, but this is time consuming, expensive, and potentially dangerous. Simple computer based driving simulators have been developed to help determine driving ability. Although patients with OSA have been shown to perform poorly compared with matched controls, it is not known whether these simulators can predict those at most risk of accidents. In this study we evaluated whether data derived from a simple driving simulator provided information over and above that obtained from the history and a sleep study that might be useful for advising patients about driving. METHODS: We examined 150 patients admitted for routine sleep studies for investigation of OSA and snoring. Each patient performed a 20 minute driving simulation and completed a questionnaire regarding their driving history and experience. RESULTS: Logistic regression analysis was used to investigate factors associated with patients' performance on the simulator. It was found that patient characteristics, older age (OR 1.05, 95% CI 1.01 to 1.09, p<0.01), female sex (OR 9.32, 95% CI 1.09 to 79.4, p<0.04), and self-reported alcohol consumption (OR 1.04, 95% CI 1.01 to 1.07, p<0.01) had the greatest influence; however, the number of self-reported near miss accidents was independently associated with a poor performance (OR 2.62, 95% CI 1.00 to 6.88, p<0.05). A further logistic regression was used to investigate whether clinical history, sleep study results, and data from the driving simulator were useful in classifying patients with OSA as having had an RTA. The number of off-road events per hour on the simulator was independently associated with a history of previous RTA (OR 1.004, 95% CI 1.0004 to 1.008, p<0.03). The Epworth score was independently associated with episodes of falling asleep at the wheel (OR 1.21, 95% CI 1.12 to 1.31, p<0.00001) and near miss accidents (OR 1.15, 95% CI 1.07 to 1.23, p<0.0001). Using this model, 100% of patients who did not have an accident could be identified, but only 10% of those who did. CONCLUSIONS: Although factors not directly related to OSA influence performance on a driving simulator, there is an independent relationship between driving ability in patients with OSA and performance on a simple computer based simulator. When combined with clinical history, it is those not reporting hypersomnolence and not having off-road events on the simulator who appear to be at least risk of adverse driving events. Poor performance on the simulator, however, relates poorly to accident history. These data require confirmation in future studies before simple computer simulators can be used in clinical practice to advise whether an individual is safe to drive.

Accidents, Traffic↗
PubMed2001

Continuous positive airway pressure for sleep apnoea/hypopnoea syndrome: usefulness of a 2 week trial to identify factors associated with long term use.

BACKGROUND: The sleep apnoea/hypopnoea syndrome (SAHS) is common and treatment with continuous positive airway pressure (CPAP) is effective. However, not all patients can cope with the demands of using mask positive pressure. Compliance can be improved with an intensive educational programme and patient support, but this is not practical in most centres given the large numbers of patients coming forward for treatment. Several studies have evaluated correlations between various parameters at diagnosis in order to anticipate patients' behaviour and to avoid the social and health implications of undertreated SAHS. We have evaluated the use of additional data derived during a 2 week home CPAP trial to identify factors associated with longer term use of CPAP and compliance. METHODS: Following a diagnostic study, 209 patients were offered a CPAP machine for a 2 week home trial. After completing the trial, patients were reassessed and scored their overall satisfaction with CPAP treatment on a five point scale ranging from "much worse" to "much better" and an Epworth score relating to the loan period. Machine run time was recorded from the integral clock. These data were added to those available at diagnosis to construct models indicative of continuing CPAP and average nightly use at 1 year. RESULTS: 209 patients were offered the 2 week loan at least a year before June 1999 (90.9% men, mean (SD) age 51.0 (10.6) years, body mass index (BMI) 34.6 (7.7) kg/m(2), Epworth score 15 (IQR 11-18), apnoea/hypopnoea index (AHI) 38.1 (22.9) events/h). 153 patients (73.2%) opted to continue CPAP and 56 declined. One year later data were available for 187 patients; 128 (68.5% on an intention to treat analysis) continued to use the machine with a mean use of 5.0 (2.4) hours/night. A logistic regression model indicated that mean CPAP use during the loan period and the overall satisfaction score accurately defined continuing CPAP and "satisfactory" CPAP use at 1 year. For patients with low machine use and no symptomatic improvement during the loan period, the addition of baseline AHI, baseline Epworth score, and the Epworth score at the end of the loan to the equation identifying factors associated with "satisfactory" CPAP use (mean >2 hours/night) improved the value of the model. CONCLUSION: Data derived from a 2 week CPAP trial are useful in identifying patients who will comply with CPAP treatment to 1 year. It can be used to identify patients with significant symptomatic disease who will struggle with CPAP and may benefit from additional education and support. High mean hourly use and a high degree of overall satisfaction during the loan period identified patients likely to use CPAP and be compliant with it at 1 year.

Adult↗
PubMed2001

Missed appointments in general practice: retrospective data analysis from four practices.

Little is known about which patients miss appointments or why they do so. Using routinely collected data from four practices, we aimed to determine whether patients who missed appointments differed in terms of their age, sex, and deprivation scores from those who did not, and to examine differences between the practices with respect to missed appointments. The likelihood of someone missing at least one appointment was independently associated with being female, living in a deprived area, and being a young adult. Living in a deprived area was associated with a threefold increase in the likelihood of missing an appointment, and the extent of this association was the same across all four practices. Interventions aimed at reducing missed appointments need to be based upon these findings.

Adolescent↗
PubMed2000

Vascular endothelial growth factor (VEGF) in breast cancer: comparison of plasma, serum, and tissue VEGF and microvessel density and effects of tamoxifen.

The assessment of angiogenesis in breast cancer is of importance as a key indicator of survival and response to therapy. Circulating vascular endothelial growth factor (VEGF) measurements may provide a less subjective analysis than microvessel density (MVD) or immunohistochemical analysis of VEGF expression; however, most studies have used serum, which is now known to largely reflect platelet-derived VEGF concentrations. This study examined for the first time both plasma (VEGFp) and serum (VEGFs) VEGF concentrations in 201 blood samples from pre- and postmenopausal healthy controls and from patients with benign breast disease, localized breast cancer, breast cancer in remission, or metastatic breast cancer and related these to other clinicopathological markers. VEGFp but not VEGFs concentrations of patients with localized disease were significantly elevated compared with normal controls (P = 0.016). Patients with metastatic disease had higher VEGFp and VEGFs levels than normal controls (P < 0.001, P = 0.044 respectively), and higher VEGFp, but not VEGFs, than patients with benign disease (P = 0.009) and patients with localized disease (P = 0.004). However, the highest VEGFp and VEGFs concentrations were seen in patients in remission compared with normal controls (P < 0.001 and P = 0.008, respectively). VEGFp concentrations in patients in remission were also higher than in patients with benign disease (P = 0.01) or patients with localized disease (P = 0.005). Tamoxifen treatment was significantly associated with higher circulating and platelet-derived VEGF levels. Circulating VEGF did not correlate with any clinicopathological factor, including MVD or VEGF expression. VEGF expression was significantly correlated with estrogen receptor status and inversely correlated with tumor grade. MVD correlated with tumor size. Tamoxifen-induced increases in VEGF may be important in clinical prognosis or associated pathologies.

Adult↗
PubMed2000

The influence of supernumerary embryos on the clinical outcome of IVF cycles.

PURPOSE: To assess the influence of the presence of quality supernumerary embryos on the clinical outcome and risk of multiple conception in patients having their first in vitro fertilization (IVF) cycle. METHODS: Retrospective cohort study of 1448 women having their first IVF treatment cycle who received 4004 embryos where at least six embryos were available for transfer treated in an Assisted Conception Unit based in a large teaching hospital. RESULTS: The replacement of three rather than two embryos to women under 35 years who had good-quality supernumerary embryos resulted in a higher twin (12.5 vs. 11.9%) and triplet birth rates (2.1 vs. 0%), without significantly improving the clinical pregnancy (50.5 vs. 45.2%) or total live birth rates (38.9 vs. 35.7%). In the absence of quality spare embryos, these women who had three rather than two embryos replaced had a significantly higher clinical pregnancy rate (39.3 vs. 28.8%; P = 0.04), total live birth (32.7 vs. 19.4%; P = 0.02) and singleton birth rate per cycle (20.8 vs. 14.4%; P = 0.04), without significantly influencing the multiple birth rate. In women over 35 years, the replacement of three instead of two embryos in the presence or absence of quality supernumerary embryos led to a significant improvement in clinical outcome, without being associated with a concurrent increase in the multiple birth rate. Women in both age groups who had either two or three embryos replaced in the presence of quality supernumerary embryos had a notably better clinical outcome compared with their counterparts who had the same number of embryos replaced, but with no quality embryos to spare. CONCLUSIONS: The presence of good-quality supernumerary embryos can be used as a reference to determine the optimal number of embryos to transfer and as an indicator of the probability of success of an individual couple in a given cycle. Optimal pregnancy rates and simultaneous reduction of multiple gestation can be achieved with a flexible embryo replacement policy that is based on embryo quality, maternal age, and the presence or absence of surplus quality embryos.

Adult↗
PubMed2000

Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy.

BACKGROUND: Cerebral palsy is the commonest cause of severe physical disability in childhood. For many years treatment has centred on the use of physiotherapy and orthotics to overcome the problems of leg spasticity, which interferes with walking and can lead to limb deformity. Intramuscular botulinum toxin (BT-A) offers a targeted form of therapy to reduce spasticity in specific muscle groups. AIMS: To determine whether intramuscular BT-A can improve walking in children with cerebral palsy. DESIGN: Randomised, double blind, placebo controlled trial. METHODS: Forty patients with spastic diplegia or hemiplegia were enrolled. Twenty two received botulinum toxin and 18 received placebo. The primary outcome measure was video gait analysis and secondary outcome measures were gross motor function measure (GMFM), physiological cost index (PCI), and passive ankle dorsiflexion. RESULTS: Video gait analysis showed clinically and statistically significant improvement in initial foot contact following BT-A at six weeks and 12 weeks compared to placebo. Forty eight per cent of BT-A treated children showed clinical improvement in VGA compared to 17% of placebo treated children. The GMFM (walking dimension) showed a statistically significant improvement in favour of the botulinum toxin treated group. Changes in PCI and passive ankle dorsiflexion were not statistically significant. CONCLUSION: The study gives further support to the use of intramuscular botulinum toxin type A as an adjunct to conventional physiotherapy and orthoses to reduce spasticity and improve functional mobility in children with spastic diplegic or hemiplegic cerebral palsy.

Adolescent↗
PubMed1999

Prevalence of back, neck and shoulder problems in the inner city: implications for the provision of physiotherapy services in primary healthcare.

BACKGROUND AND PURPOSE: More general practitioners are offering physiotherapy services within primary healthcare; however, this provision may result in increased demand. Resource allocation, based on previous patterns of consultation for musculoskeletal conditions, may be inadequate since the need for treatment in the community may not have been met in the past. Therefore the aim of this study was to determine the prevalence of back, neck and shoulder problems that had restricted normal activity for more than one week during the last year and which health professionals (if any) patients had consulted about their symptoms. METHOD: A postal survey of 2400 adult patients selected at random from four general practices in Newcastle upon Tyne (600 from each practice). RESULTS: A total of 1546 questionnaires were returned, a 64% response rate. Overall, 40% of respondants reported having at least one back, neck and/or shoulder problem. Back problems were most common (30%), followed by those with neck (21%) and shoulder (20%) problems. Approximately one-third of those with problems consulted no one, a further third consulted a general practitioner and only one in six consulted a physiotherapist. CONCLUSIONS: There is a high prevalence of substantial back, neck and shoulder problems in the community and thus a wider provision of physiotherapy services within primary healthcare may be required to manage the considerable levels of potentially unmet need.

Adolescent↗
PubMed1999

The influence of donated gametes on the incidence of hypertensive disorders of pregnancy.

Pregnancies achieved from oocyte, sperm or embryo donation are unique, since they have resulted from donor gametes that are immunologically foreign to the mother. Thus, studying the obstetric outcome of such pregnancies may shed some light on the pathophysiology of preeclampsia, particularly in women conceiving with donated embryos, since the entire fetal genome is allogenic in these pregnancies. In this retrospective cohort study, a total of 144 women were studied. Of these, 72 were infertility patients who had conceived as a result of sperm, ovum or embryo donation and the other 72 women were age- and parity-matched control patients who became pregnant with their own gametes, either spontaneously, or following intrauterine insemination with their partner's spermatozoa. Study patients were divided into three groups depending on the origin of the donated gametes. Group 1 consisted of pregnancies achieved by intrauterine insemination with washed donor spermatozoa (n = 33). Group 2 included women who conceived using donated oocytes (n = 27) and group 3 consisted of women who conceived as a result of embryo donation (n = 12). The incidence of pregnancy-induced hypertension in the donated gametes study group was 12.5% (9/72) compared with 2.8% (2/72) in the control group. In addition, pre-eclampsia was diagnosed in 18.1% (13/72) of the donated gametes study group compared to 1.4% (1/72) in the age- and parity-matched controls. The increased incidence of gestational hypertension in pregnancies resulting from donated gametes gives evidence for a maternal genetic component, with an equally strong fetal influence, in the complicated aetiology of gestational hypertension, and pre-eclampsia in particular.

Cohort Studies↗